Durable 5-year local control for resected brain metastases with early adjuvant SRS: The effect of timing on intended-field control Journal Article

   

Authors:	Bander, E. D.; Yuan, M.; Reiner, A. S.; Panageas, K. S.; Ballangrud, Å M.; Brennan, C. W.; Beal, K.; Tabar, V.; Moss, N. S.
Article Title:	Durable 5-year local control for resected brain metastases with early adjuvant SRS: The effect of timing on intended-field control
Abstract:	Background. Adjuvant stereotactic radiosurgery (SRS) improves the local control of resected brain metastases (BrM). However, the dependency of long-term outcomes on SRS timing relative to surgery remains unclear. Methods. Retrospective analysis of patients treated with metastasectomy-plus-adjuvant SRS at Memorial Sloan Kettering Cancer Center (MSK) between 2013 and 2016 was conducted. Kaplan-Meier methodology was used to describe overall survival (OS) and cumulative incidence rates were estimated by type of recurrence, accounting for death as a competing event. Recursive partitioning analysis (RPA) and competing risks regression modeling assessed prognostic variables and associated events of interest. Results. Two hundred and eighty-two patients with BrM had a median OS of 1.5 years (95% CI: 1.2-2.1) from adjuvant SRS with median follow-up of 49.8 months for survivors. Local surgical recurrence, other simultaneously SRS-irradiated site recurrence, and distant central nervous system (CNS) progression rates were 14.3% (95% CI: 10.1-18.5), 4.9% (95% CI: 2.3-7.5), and 47.5% (95% CI: 41.4-53.6) at 5 years, respectively. Median time-toadjuvant SRS (TT-SRS) was 34 days (IQR: 27-39). TT-SRS was significantly associated with surgical site recurrence rate (P = 0.0008). SRS delivered within 1 month resulted in surgical site recurrence rate of 6.1% (95% CI: 1.3-10.9) at 1-year, compared to 9.2% (95% CI: 4.9-13.6) if delivered between 1 and 2 months, or 27.3% (95% CI: 0.0-55.5) if delivered >2 months after surgery. OS was significantly lower for patients with TT-SRS >~2 months. Postoperative length of stay, discharge to a rehabilitation facility, urgent care visits, and/or disease recurrence between surgery and adjuvant SRS associated with increased TT-SRS. Conclusions. Adjuvant SRS provides durable local control. However, delays in initiation of postoperative SRS can decrease its efficacy. © The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved.
Keywords:	adult; human tissue; aged; major clinical study; overall survival; intensity modulated radiation therapy; squamous cell carcinoma; adjuvant therapy; nuclear magnetic resonance imaging; endometrium cancer; melanoma; computer assisted tomography; ovary cancer; breast cancer; radiation; cohort analysis; recurrence; retrospective study; central nervous system; prostate cancer; sarcoma; brain metastasis; stomach cancer; bile duct carcinoma; thyroid cancer; stereotactic radiosurgery; postoperative; transitional cell carcinoma; cone beam computed tomography; volumetric modulated arc therapy; non small cell lung cancer; recursive partitioning; planning target volume; human; male; female; article
Journal Title:	Neuro-Oncology Practice
Volume:	8
Issue:	3
ISSN:	2054-2577
Publisher:	Oxford University Press
Date Published:	2021-06-01
Start Page:	278
End Page:	289
Language:	English
DOI:	10.1093/nop/npab005
PROVIDER:	scopus
PMCID:	PMC8153823
PUBMED:	34055375
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85108008583&doi=10.1093%2fnop%2fnpab005&partnerID=40&md5=f2dbf46ed465497fc00ec7da9bc56a84
Notes:	Article -- Export Date: 1 July 2021 -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/182410